Women Have Less Access to Surgery in War-Ravaged Countries

Data on surgeries conducted by Doctors Without Borders in humanitarian projects in 12 war-torn countries in Africa and the Middle East, show between 2008 and 2014, the nonprofit organization performed the majority- 69% - of its nearly 50,000 operations in those countries on men.

“Working in low-income countries, primarily in sub-Saharan Africa, it has become obvious to me that women are underrepresented in the hospitals,” said Dr. Sherry Wren, professor and vice chair of surgery at Stanford University School of Medicine in Stanford, California, in a study.

“I’m concerned that women are having less access to surgery in these countries,” she told Reuters Health. “We don’t know causality here. My hypothesis is we’re looking at a societal judgment about how women are valued.”

The study analyzed surgical procedures from Doctors Without Borders projects, which, unlike other healthcare facilities in the regions, offer services for free. Most of the operations were performed in Afghanistan, the Democratic Republic of the Congo, Pakistan and South Sudan on civilians whose ages ranged from 1 to 105 years old.

In predominantly Muslim countries, men were 70% more likely to have surgical interventions, Wren found, although she believes the disparity likely stems not from religion but from culture.

Not surprisingly, men more frequently were treated for violent trauma, including injuries from bombs, gunshots and knives, Wren and her colleagues reported in the journal Surgery on April 8. But 73% of the interventions for nonviolent trauma, such as burns and vehicle accidents, also were performed on men.

 Sounding the Alarm

Dr. Barclay Stewart, a surgery resident at the University of Washington in Seattle, who was not involved in the study, said he has seen far more male patients while working in Ghana, Nepal, Kenya and South Sudan. The study “sounds an alarm,” he said.

“It comes at a time marked by the highest proportion of persons displaced by conflict and disaster in history. The study should make us all concerned we’re not doing enough to be sure that women receive equal surgical care as men, have equal access to surgical care and have an equal understanding of conditions that require surgical care.”

Women get more than half the operations in higher-income countries, Wren said. She said she does not know what drives the gender disparity in areas marked by armed conflicts.

“But I think it’s the same value judgments that keep males in school longer,” she said. “It’s all about gender-based value decisions.”

While healthcare may be less accessible to women than men during armed conflict, today’s wars make accessing care challenging for everyone, Stewart said.

“The war is happening on people’s front door steps. There are no enemy lines. It’s all entangled with civilians, women and children. There are so many barriers to care at all levels that there’s no silver bullet to overcome it, particularly for women.”